Lung Cancer Flashcards
2 Main subtypes of lung cancer
Non small cell lung cancer (80%) and Small cell lung cancer (20%)
Subtypes of NSCLC
Adenocardinomas (40%), squamous cell carcinoma (20%), large cell carcinoma (10%), other types (10%)
What do small cell lung cancers contain
Neurosecretory granules which can release neuroendocrine hormones
What can small cell lung cancers cause
Paraneoplastic syndromes
Signs and symptoms of lung cancer
SOB, cough, haemoptysis, finger clubbing, recurrent pneumonia, weight loss, lymphadenopathy
Findings in CXR suggestive of lung cancer
Hilar enlargement, peripheral opacity, pleural effusion, collapse
Investigations into lung cancer
CXR, Staging CT scan, PET-CT, bronchoscopy with endobronchial US, histological diagnosis with biopsy
First line treatment in non-small cell lung cancer
If isolated to single area then surgery - lobesctomy, segmentectomy or wedge resection
Prognosis of SCLC
Worse than NSCLC
What does endobronchial treatment involve
Stents or debulking can be used as part of palliative treatment to relieve bronchial obstruction caused by lung cancer
Extrapulmonary manifestations
REcurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, Horner’s syndrome, SIADH, Cushing’s. hypercalcaemia, limbic encephalitis, LEMS
Symptoms of recurrent layngeal nerve palsy
Hoarse voice from cancer pressing on or affecting nerve as it passes through mediastinum
Symptoms of phrenic nerve palsy
Nerve compression causes diaphragm weakness and presents as SOB
Symptoms of SVC obstruction
Caused by direct compression of tumour presenting with facial swelling, difficulty breathing, distended veins in neck and upper chest and Pemberton’s sign
What is Pemberton’s sign
Raising hands over the head causes facial congestion and cyanosis
Symptoms of Horner’s syndrome
Triad of partial ptosis, anhidrosis and miosis caused by Pancoast tumours pressing on sympathetic ganglion
Where is a pancoast tumour
Pulmonary apex
Cause of Cushing’s
Ectopic ACTH secretion by small cell LC
Causes of hypercalcaemia
Ectopic parathyroid hormone secreted by squamous cell carcinoma
Symptoms of limbic encephalitis
short term memory impairment, hallucinations, confusion and seizures
Cause of limbic encephalitis
Small cell lung cancer causes Immune system to make antibodies to tissues in brain, specifically the limbic system.
Cause of lambert eaton myasthenic syndrome
Antibodies produced by immune system against small cell lung cancer cells, which also target voltage gated calcium channels on motor neurons
Symptoms of lambert eaton myasthenic syndrome
Weakness in proximal muscles, intraocular and levator muscle weakness (diplopia, ptosis), phayngeal muscle causing slurred speech and dysphagia, dry mouth, blurred vision, impotence and dizziness
Notable finding of patient with LEMS
Reduced tenson reflexes, which become temporarily normal for short period after strong muscle contraction
Links to mesothelioma
Asbetstos inhalation
